Tucker Daniel M D, Palmer Andrew J, Valentine William J, Roze Stéphane, Ray Joshua A
CORE - Center for Outcomes Research, a Unit of IMS, Switzerland.
Curr Med Res Opin. 2006 Mar;22(3):575-86. doi: 10.1185/030079906X96227.
To quantify changes in clinical and cost outcomes associated with increasing levels of body mass index (BMI) in a US setting.
A semi-Markov model was developed to project and compare life expectancy (LE), quality-adjusted life expectancy (QALE) and direct medical costs associated with distinct levels of BMI in simulated adult cohorts over a lifetime horizon. Cohort definitions included age (20-65 years), gender, race, and BMI (24-45 kg m(-2)). Cohorts were exclusively male or female and either Caucasian or African-American. Mortality rates were adjusted according to these factors using published data. BMI progression over time was modeled. BMI-dependent US direct medical costs were derived from published sources and inflated to year 2004 values. A third party reimbursement perspective was taken. QALE and costs were discounted at 3% per annum.
In young Caucasian cohorts LE decreased as BMI increased. However, in older Caucasian cohorts the BMI associated with greatest longevity was higher than 25 kg m(-2). A similar pattern was observed in young adult African-American cohorts. A survival paradox was projected in older African-American cohorts, with some BMI levels in the obese category associated with greatest longevity. QALE in all four race/gender cohorts followed similar patterns to LE. Sensitivity analyses demonstrated that simulating BMI progression over time had an important impact on results. Direct costs in all four cohorts increased with BMI, with a few exceptions.
Optimal BMI, in terms of longevity, varied between race/gender cohorts and within these cohorts, according to age, contributing to the debate over what BMI level or distribution should be considered ideal in terms of mortality risk. Simulating BMI progression over time had a substantial impact on health outcomes and should be modeled in future health economic analyses of overweight and obesity.
在美国背景下，量化与体重指数（BMI）水平升高相关的临床和成本结果变化。
开发了一个半马尔可夫模型，以预测和比较模拟成年队列在一生时间范围内与不同BMI水平相关的预期寿命（LE）、质量调整预期寿命（QALE）和直接医疗成本。队列定义包括年龄（20 - 65岁）、性别、种族和BMI（24 - 45千克/米²）。队列仅分为男性或女性，以及白种人或非裔美国人。使用已发表数据根据这些因素调整死亡率。对BMI随时间的进展进行建模。依赖BMI的美国直接医疗成本来自已发表来源，并折算为2004年的值。采用第三方报销视角。QALE和成本按每年3%进行贴现。
在年轻白种人队列中，LE随BMI升高而降低。然而，在老年白种人队列中，与最长寿命相关的BMI高于25千克/米²。在年轻成年非裔美国人队列中观察到类似模式。在老年非裔美国人队列中预计存在生存悖论，肥胖类别中的某些BMI水平与最长寿命相关。所有四个种族/性别队列中的QALE与LE遵循相似模式。敏感性分析表明，模拟BMI随时间的进展对结果有重要影响。所有四个队列中的直接成本随BMI增加，但有少数例外。
就寿命而言，最佳BMI在种族/性别队列之间以及这些队列内部因年龄而异，这引发了关于就死亡风险而言应将何种BMI水平或分布视为理想的争论。模拟BMI随时间的进展对健康结果有重大影响，应在未来超重和肥胖的健康经济分析中进行建模。
